The Analysis Of Clinical Effect Of Mild Hypothermic Circulatory Arrest On Stanford Type A Disection Patient

Object:By retrospectively analyzing the clinical data of patients underwent total arch replacement+ stent graft implant,we evaluate the effectiveness of mild hypothermic circulatory arrest(MiHCA)in Stanford Type A Aortic Dissection.We also compare the data of MiHCA with moderate hypothermic circulatory arrest(MoHCA)and deep hypothermic circulatory arrest(DHCA)to determine the optimal strategy for hypothermic circulatory arrest(HCA),provides guidance for future clinic practice.Methods:Retrospectively analyzing the clinical data of patients with Standford type A aortic dissection underwent Sun's procedure from September 2014 to September 2016,we adopted propensity score matching to match those patients and divided them into MiHCA(30-31 ?),MoHCA(25-28 ?)and DHCA(18-20 ?)according to the strategy employed during HCA.The clinical results,including cardiopulmonary bypass time,aortic cross-clamp time,postoperative neurological deficit,postoperative transfusion,time of mechanical ventilation,continuous renal replacement therapy,ALT,AST and so on,were compared and analyzed.Results:130 cases were match by using the propensity score matching.There is no statistic difference in age,sex and medical history among three groups.The queue analyze shows there is statistic difference among three groups in operation time,CPB time,chest drainage within 48 hours,ventilation time,postoperative paraplegia and infarction(P<0.05),while no statistic difference in transfusion,mortality,creatinine,AlT,DBIL,ICU stay,hospital time,transient neural deficit and so on(P>0.05).In detail,the operation time and CPB time in MiHCA group is significantly shorted than those in DHCA group(P=0.003 and 0.005 respectively),and there is significantly lesser chest drainage within 48 hours,postoperative paraplegia and infarction in MiHCA group than in DHCA group(P<0.001 and P=0.018 respectively).Conclusion:Comparing with MoHCA(25-28 ?)and DHCA(18-20 ?),MiHCA(30-31 ?)strategy is a safe and effective approach for Stanford type A aortic dissection that can significantly reduce postoperative complication and achieve satisfactory clinical outcome.